Provider Demographics
NPI:1598039638
Name:DR. MARY ANN WEBER, DDS, MSOM, LAC
Entity Type:Organization
Organization Name:DR. MARY ANN WEBER, DDS, MSOM, LAC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSOM, LAC
Authorized Official - Phone:707-544-1910
Mailing Address - Street 1:763 NEBRASKA DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-7131
Mailing Address - Country:US
Mailing Address - Phone:707-544-1910
Mailing Address - Fax:
Practice Address - Street 1:1049 4TH ST STE D
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4345
Practice Address - Country:US
Practice Address - Phone:707-544-1910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 14124171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty